grievances and appeals auditor in cerritos

posted
job type
contract
salary
US$ 32 per hour
apply now

job details

posted
location
cerritos, california
job category
Legal
job type
contract
salary
US$ 32 per hour
reference number
435772
phone
404-942-4619
apply now

job description

job summary:

Grievances and Appeals Auditor - Cerritos, CA

  • This is a contract role expected to last 4 months.

Grievances and Appeals Auditor - Job Duties:

  • Responsible for post completion examination of grievances and appeals in multiple states. Primary duties may include, but are not limited to: Reviews case to determine applicability of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards.
  • Reviews case to assess whether it was appropriately handled as a clinical or administrative request and was correctly processed to avoid prompt pay penalties.
  • Evaluates urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review.
  • Reviews case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation.
  • Assists management in process improvement strategies to achieve business objectives. Prepares audit findings and recommendations for G&A associates and management on a monthly basis. Identifies and communicates error trends to improve overall quality of enterprise G&A team.

Job Requirements:

  • Requires a BA/BS degree, a minimum of 2 years of grievance and appeals experience; or any combination of education and experience which would provide an equivalent background.

Compensation: $32.00-$37.10/hr

 
location: Cerritos, California
job type: Contract
salary: $32.00 - 37.10 per hour
work hours: 8 to 5
education: Bachelor's degree
experience: 2 Years
 
responsibilities:

Responsibilities:

Responsible for post completion examination of grievances and appeals in multiple states. Primary duties may include, but are not limited to: Reviews case to determine applicability of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards. Reviews case to assess whether it was appropriately handled as a clinical or administrative request and was correctly processed to avoid prompt pay penalties. Evaluates urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review. Reviews case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation. Assists management in process improvement strategies to achieve business objectives. Prepares audit findings and recommendations for G&A associates and management on a monthly basis. Identifies and communicates error trends to improve overall quality of enterprise G&A team. Associates at this level handle routine to complex audits and function as subject matter experts.

 
qualifications:

Qualifications:

Requires a BA/BS degree, a minimum of 2 years of grievance and appeals experience; or any combination of education and experience which would provide an equivalent background.

 
skills: Compliance

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.

skills

Compliance

qualification

Qualifications:
Requires a BA/BS degree, a minimum of 2 years of grievance and appeals experience; or any combination of education and experience which would provide an equivalent background.

responsibilities

Responsibilities:
Responsible for post completion examination of grievances and appeals in multiple states. Primary duties may include, but are not limited to: Reviews case to determine applicability of, and compliance with, federal and state regulations, enterprise policies and procedures and all related accreditation standards. Reviews case to assess whether it was appropriately handled as a clinical or administrative request and was correctly processed to avoid prompt pay penalties. Evaluates urgency of clinical situation to assess appropriate handling, determine if sufficient records were obtained, and review medical records and medical policies to determine if correct criterion has been utilized in each review. Reviews case documentation to assess appropriate system entries have been made and that the step-by-step process is sufficient to mitigate risk associated with regulatory reviews, accreditation reviews, and potential litigation. Assists management in process improvement strategies to achieve business objectives. Prepares audit findings and recommendations for G&A associates and management on a monthly basis. Identifies and communicates error trends to improve overall quality of enterprise G&A team. Associates at this level handle routine to complex audits and function as subject matter experts.

educational requirements

Bachelor's degree